In December 2007, Palomar Pomerado Health broke ground on a 600-bed hospital in Escondido, Calif. Just two months later, officials held a ribbon-cutting ceremony, allowing patients, staff and others to tour Palomar Medical Center West and play with new technology deployed throughout the facility.
No, this wasn't the most rapid hospital construction in history. The ribbon cutting took place in Second Life, a 3-D, virtual world that exists entirely on the Web.
Slated to open in 2011, the bricks-and-mortar version of the medical center represents an "aggressive expansion" for Palomar Pomerado Health, says Chief Innovation Officer Orlando Portale. PPH already serves the state's largest health district but, upon completion, the new inpatient and outpatient facilities will serve roughly 1,400 square miles.
Why preview a multimillion-dollar health care complex on the Internet? "Our primary motivation was to allow our constituents to experience, rather than just see the entire project" Portale says.
And experience the project they do.
Cisco Partnership
In partnership with communications technology company Cisco (Nasdaq: CSCO) 
, PPH showcases every high-tech bell and whistle in the facility, highlighting advances in architecture and design.
Visitors to the Second Life site are known as "avatars" and appear on the screen as human images. When avatars enter the medical center lobby, they are handed a radio-frequency identification bracelet, which guides them through the entire structure and allows them to experience everything from bedside environmental control terminals to acuity-adaptable patient rooms.
Since launching in 2003, Second Life has grown dramatically, and today is "inhabited" by an estimated 13 millions users from around the world. Most users still log on to socialize and take part in a seemingly endless array of entertainment and cultural opportunities, but access to and dissemination of health care information is fast becoming a tremendous draw.
From academicians to businesses to not-for-profit organizations to patient self-help groups, users have come to realize the potential reach of their participation in this virtual universe and to explore the ways in which they might leverage that influence.
Stress Test
Massachusetts General Hospital neurologist Daniel Hoch, M.D., jumped into Second Life to determine if virtually led meditation and other relaxation techniques can reduce real-life stress. His initial eight-week pilot study, which began in July, educated and then led a group of eight participants through a virtual version of a well-established, once-weekly relaxation and meditation program, facilitated by animations and virtual objects.
The first group was intentionally small, recruited through word of mouth, kiosks posted in Second Life and real-world paper notices.
Roughly 20 individuals have been recruited for a second pilot study, which began the second week of September. So far, the sessions have gone well, Hoch says, noting that the program's facilitator is seeing essentially the same attendance and dynamics she observes in her real-world groups. Outcomes will be assessed by comparing a pre- and post-study questionnaire completed by the subjects during two face-to-face encounters.
"Similar to informed consent, which is obtained during the first real-world visit, the validity of giving research questionnaires virtually is unclear," Hoch says.
Data collection is ongoing and to date, he is reluctant to speculate what the real-world impact of this virtual experiment might be.
An Island for the CDC
Visitors to the Centers for Disease Control and Prevention's Second Life location -- CDC Island -- will find podcasts on a range of health topics or examine an actual image from the CDCs public health library by looking through a virtual microscope in a virtual lab.
Also available is a private space for in-world (inside Second Life) interviews with CDC researchers on sensitive topics such as HIV/AIDS.
The CDC also maintains a Second Life outpost where visitors attend virtual health fairs, and participates in Whyville, a Web site intended to engage 8- to 15-year-old children on a broad range of topics.
The recent introduction of CDC Island coincides with an evolution in how the agency and the public use Second Life.
Today, the focus is less on the CDC as an agency and much more on specific health-related issues and on engaging visitors in virtual behaviors that might influence real-world health decisions," says Erin Edgerton, CDCs content lead for interactive media at the National Center for Health Marketing.
For example, by partnering with Whyville, the CDC and the Web site's creators can promote a mutual goal: increasing awareness about the importance of seasonal influenza vaccines. In 2005, the CDC and Whyville released a potent virtual flu virus that covered unprotected avatars with spots. The number of avatars that then lined up for virtual flu vaccines in 2007 was double the number from the previous year.
The hope is that if people go through the motions online they are more likely to actually go out and get actual vaccinations.
Real-World Change or Fantasy Island?
Is a virtual world of anonymous, island-hopping avatars an effective, appropriate venue for promoting health issues, conducting research and even "test-driving" bricks-and-mortar facilities? Do lessons learned in the virtual world translate into real-world behaviors?
Dan Weberg, R.N., is optimistic but skeptical. "A virtual world can be useful in detecting flaws in a prototype health care model or in patient simulation for nursing education," says Weberg, a self- proclaimed "simulation tech guru," who earned a master's degree from Arizona State University's first-of-its-kind healthcare innovation program. But he isn't yet convinced that this particular innovation will translate into real-world actions or that the avatar experience provides anything beyond that found via a conventional Internet search. "It remains to be seen whether and how the lessons learned will be applied"
Variety of Uses
At Palomar Pomerado Health, the virtual tours help build support 
for its new building complex. That's important because the estimated US$773 million financing plan includes a combination of general obligation bonds, revenue bonds, operating revenues and a capital campaign conducted by the PPH Foundation.
However, something initially viewed primarily as a marketing tool and a means of recruiting clinical staff is evolving. "The virtual experience wasn't, and still isn't, set up to elicit feedback," says Portale, "but our staff members are now viewing the ability to virtually test-drive design and operational elements and equipment as a simulation and modeling tool. We can, for example, enter a patient room and experiment with where to place equipment or how to re-engineer work processes, and we can now do this without a physical mock-up."
PPH's Second Life space does not formally keep track of the numbers and types of visitors coming from outside the health care system, but it has noted some creative uses of the space. An example: virtual field trips led by college professors who want to give their students the opportunity to "experience" cutting-edge health care innovation, architecture and design.
On the Horizon
Hoch says "the possibilities are endless" with regard to clinician training, noting the already established areas for cardiac auscultation simulation, disaster preparedness and even programs that allow mental health clinicians to experience virtual hallucinations.
He hopes to use data from his pilot research to design more detailed studies and to work with self-organizing Second Lifers to promote often-overlooked components of health and wellness.
"Stroke survivors are already using games to enhance recovery and improve cognitive skills," Hoch says. "Individuals with social anxiety and autism are using the virtual world to socialize and reduce fear. I'm hoping this work will help to bring awareness into the professional realm."
The CDC is in the rearming stages for its own formal studies to measure real-world impact In the meantime, the agency is looking at research -- as well as anecdotal evidence -- on the way in which people use Web 2.0 to determine how to tap in and direct its resources.
The CDCs Edgertan cites the example of Daily Strength, a social-networking Web site organized around support groups, in which members routinely print out lists and rankings of treatments posted by fellow group members to take to their doctors' offices for discussion
"This is just one example of the way in which people are turning away from authoritative sources and toward who have lived what they're experiencing," she says.
